An audit of the use of antifungal agents

A three month prospective audit of systemic antifungal therapy was undertaken in a university hospital in the United Kingdom to determine the patterns of usage of systemic antifungal drugs. The case notes of all patients receiving systemic antifungal agents were reviewed daily and the appropriateness of therapy was determined according to standards in the authoritative literature. One hundred and fifteen courses of treatment with antifungal agents for 1481 days were administered to 74 patients. When a patient had received more than one course of antifungals, both the individual courses and the combination of courses, i.e. a regimen, were judged. Antifungal agents were given as an empirical therapy or as prophylaxis in 68% of the courses, with fluconazole and amphotericin B desoxycholate being the agents most frequently used. Therapy was considered unconventional in 26.9% of the courses and 40.5% of the regimens, mainly because either the indication or the duration of treatment did not conform to conventional practice. Improvement in prescribing practices and standards for ongoing audit can only be achieved if a consensus can be reached on how these agents can be used appropriately.